Thoracic aorta units: an opened avenue to cardiologists.

We read with great interest an article in the journal byCollart et al. regarding endovascular treatment of aruptured thoracic aneurysm [1]. Thoracic aortic aneurysmsand dissections are life-threatening conditions and pose asignificant challenge to the surgeon. The incidence ofthoracic aortic aneurysms is approximately 6 per 100,000persons per year [2]. Surgical repair with prosthetic graftis the traditional therapy and is associated with operativemortalities of 5–20% [3]. During the last few years,endovascular stent grafting has emerged as an alternativetreatment to this disease. Compared to traditional surgicalrepair, endovascular treatment is associated to reducedmorbidity and mortality [4,5]. It is significantly lessinvasive and accepted within the current environment ofcost reduction in the health-care system. The endovas-cular approach can be useful in different thoracic lesionssuch as aneurysms, pseudoaneurysms, acute aortic syn-dromes and chronic dissections. It can be the first linetreatment in elderly patients and in patients with seriouscomorbidities.The creation of thoracic aorta units has been conceivedto plan the better strategy (endovascular vs. surgicalapproach) to treat patients with thoracic aortic diseasesand has opened a new avenue for interventional andcardiac imaging cardiologists. A multidisciplinary teamintegrated by vascular and cardiac surgeons, radiologists,anaesthetists and cardiologists evaluate all individualcases and select the better treatment for each patient. Acorrect selection of the cases and the exact knowledge ofthe anatomic conditions are essential for procedure’ssuccess.The thoracic aorta unit of our hospital selected 22patients (20 men, 63.4T9 years) for endovascular stentgrafting between December 2001 and December 2004.Implantation causes are shown in Table 1. Six procedureswere considered emergencies. Two patients underwent priorsurgery of the supra-aortic branches. Previous computedtomographic angiography and arteriography were per-formed, and in complex cases of dissection, magneticresonance imaging was used. All stent placement proce-dures were performed in the cardiac catheterizationlaboratories. Stent delivery was technically successful in21 patients. The mean length of aortic coverage was230T110 mm (range 110–440 mm). One intraoperativedeath occurred. There was one in-hospital death not relatedwith the procedure. Transient postimplantation syndrome